Intervention to Prevent Mental Ill-Health among Health Care Workers

Article excerpt

Introduction

The tasks, organization, and management of work, as well as the social and environmental contexts of work can influence an employee's mental and physical health in various ways (Cox et al., 2000). The ways these various factors of work interact and influence the employee have been summarized in models such as the Demand-Control Model (Karasek and Theorell, 1990) and the Effort-Reward Imbalance Model (Siegrist, 1996). In a meta-analysis of many empirical studies based on these models, there was consistent support for the finding that a combination of high demands, low-decision latitude, and low rewards in the psychosocial work environment creates risk factors for the development of mental disorders (Stansfeld and Candy, 2006). The Job Demands- Resources Model (Bakker et al., 2004) emphasizes how the conditions at work can affect the employees' health both negatively and positively. Demands at work are not necessarily always negative, and may also contribute to employees' growth, learning, and development (Bakker and Demerouti, 2007). Subjective well-being as a type of health outcome has also been studied in relation to work environment factors. Stansfeld et al. (2013) have shown that psychosocial work environment factors and personal social support have significance when it comes to well-being.

In health care, employees are constantly engaging in personal interactions with people in need of medical attention and care. "The available scientific evidence suggests that those who work in the healthcare setting, especially with direct contact with and responsibility for patients and other people, may be particularly at risk from the experience of work-related stress" (Cox et al., 2002, p. 3). Mental strain in health care is characterized by high demands on one's competence and ability to relate to and empathize with the patient's problem, combined with the demand for professional objectivity. Furthermore, these demands must be fulfilled in a work environment characterized by tight time pressure and a situational-driven work process that changes according to patients' different needs (Firth-Cozens and Payne, 1999; Peterson, 2003; Su et al., 2009). Psychological strains, often a combination of several different strains, may in some cases be overwhelming for health care employees, leading to short-term or long-term signs of mental ill-health, which may even lead to sickness absenteeism (Gillespie and Melby, 2003; Michie and Williams, 2003; Rugulies et al., 2007).

Within the health care industry, structural changes, financial cutbacks, and extensive reorganizations (Borrill and Parker, 2000; Waris, 1999) have been made based on strictly financial reasoning, with expectations for improved quality and shortened time spent under care. Organizations have made cutbacks, merged, and shifted focus, which means that employees' social networks and social support have been disrupted, work duties have changed, employment has become less secure, and personnel turnover is high (Harvey et al., 2003; Mackie et al., 2001). The nature of one's occupation, together with its place in the organizational hierarchy, could play an indirect role in the production of distress, considering the fact that different professions/occupations operate under different conditions and experience different types of strains (Marchand et al., 2005). The professions relevant in this study within a hospital clinic are doctors, midwives, nurses, and other health care personnel such as licensed practical nurses and medical assistants. Health care in Sweden is currently characterized by a high level of complexity as the traditional hierarchy among professional groups is undergoing changes. New forms of collaboration are necessary among employees, especially in the health care professions. These structural factors have increased the strains, stress, and mental ill-health among employees (Davidson et al., 1997).

Furthermore, organizational management and personnel support structures appear to be of great importance for employees' mental health. …